Appendix 1: Integrated Urgent Care Service Update. 1. Purpose

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1 Appendix 1: Integrated Urgent Care Service Update 1. Purpose The purpose of this paper is to provide Governing Body members across the collaborative CCGs with an update on the progress of the Integrated Urgent Care (IUC) project, to outline the guidance and process regarding Conflict of Interest and to seek delegated authority to be given for the approval of the full commissioning case. 2. Context South Essex CCGs, being Basildon and Brentwood CCG, Castle Point and Rochford CCG, Southend CCG and Thurrock CCG, and North Essex CCGs, being Mid Essex CCG and West Essex CCG, are working collaboratively to redesign an Integrated Urgent Care service (formally NHS 111 and Out of Ours (OOH) Service) for the population of the six CCGs across mid, south and west Essex. In 2013, the South Essex CCGs undertook a procurement exercise for integrated NHS 111 and OOHs Services. The contracts were awarded to IC24 (IC24) for a period of three years to 31 March 2016 with an optional two 12 month extensions (total five years). The first one year extension has been taken and the contract currently expires on 31 March There is an option available for a further one year extension. In August 2013 the North Essex CCGs procured an NHS 111 service, also with IC24 under a 17 month contract expiring in April This contract was extended by variation to April 2016 and is now being extended to meet the timeline of this project. Each of the North Essex CCGs has a separate OOH contract, all of which are due to expire in March 2017 and therefore require extension to meet the timeline of this project. These contracts are currently with PELC for West Essex and Primecare for Mid Essex. Due to the nature of the services, the provision of the Integrated Urgent Care service needs to undergo a formal procurement exercise and must as a minimum comply with National Commissioning Standards released in October 2015 and any subsequent releases and national requirements. In conjunction with the Five Year Forward View (FYFV) the requirement to re-procure has provided the opportunity to review current service provision across mid, south and west Essex and redesign these services to meet the urgent care needs of the local population. In early summer 2016, the seven Essex CCGs took the decision to approach this as a collaborative project across Essex. Subsequently, North East Essex withdrew from the project to align with their STP footprint.

2 3. Integrated Urgent Care National Policy and NHS publications clearly define the purpose and role of Integrated Urgent Care within the future of care delivery. The NHS Five Year Forward View 1 (FYFW) outlines the redesign and integration of urgent and emergency care services to simplify the system, helping patients get the right care, at the right time, in the right place, and making more appropriate use of alternatives to higher acuity services such as ambulance and A&E. The national vision is that an Integrated Urgent Care service, supported by an Integrated Clinical Advice Service (Clinical Hub) will assess the needs of people and advise on or access the most appropriate course of action, including: Where clinically appropriate, people who can care for themselves will be provided with information, advice and reassurance to enable self-care. Where possible, people will have their problem dealt with over the phone by a suitably qualified clinician. People requiring further care or advice will be referred to a service that has the appropriate skills and resources to meet their needs. People facing an emergency will have an ambulance dispatched without delay. 999 will continue to provide an emergency service whilst 111 will take all calls requiring urgent but not emergency care. The offer to the public is a single entry point NHS to fully integrated urgent care services in which organisations collaborate to deliver high quality, clinical assessment, advice and treatment and to shared standards and processes and with clear accountability and leadership (NHS Integrated Urgent Care Commissioning Standards, Oct 2015). 4. Project Objectives The project objectives are to: Develop a clinical quality focused, accessible and responsive Integrated Urgent Care Service that is consistent with the project deliverables. Deliver localisation within service design and delivery across mid, south and west Essex Deliver an effective, high performing quality and patient focused Integrated Urgent Care Service; and which is sustainable, value for money, and offers flexible to incorporate new ideas and approaches. 5. Progress to Date Following the development and approval of the Project Initiation Document (PID), a formal Programme Board and supporting Project Delivery Group were established, with representation from the six collaborating CCGs. The Senior Responsible Officer for the 1 NHS Five Year Forward View, October

3 project is Robert Shaw, Joint Director of Acute Commissioning and Contracting for Castle Point and Rochford CCG and Southend CCG. Additional workstreams were established focussing on: Clinical Design, Communications and Engagement, Finance and Activity, Procurement and Enablers (including IM&T and Estates). An update on each workstream is summarised below: 5.1 Clinical Design The overarching clinical leads for the project are Dr Donald McGeachy and Dr Roger Gardiner who are leading the clinical design workstream. Essex-wide scoping workshops were held in May and June, with good representation from across the Essex systems and spanning acute, community, primary care, social care, hospices, commissioners, urgent care providers and the voluntary sector. To inform the service model and specification a number of workshops and engagement events have taken place, or are planned during September, across the CCGs. This included a successful clinical leads workshop on 1 September, with a further session planned for late September. The draft specification is currently being reviewed by members of the Programme Board and Project Delivery Group and is on track to be finalised by early October. The Clinical Design workstream will also develop local quality requirements and key performance indicators and undertake equality and quality impact assessments. 5.2 Communications and Engagement A Communications and Engagement plan for this phase of the project has been developed and is currently being delivered. The public engagement element is being delivered by Enable East, with drop in sessions being held across the CCG localities in mid-september. Leaflets and an online survey have been produced and circulated, with feedback to be collated by the end of September. Clinical engagement is being delivered by members of the Clinical Design workstream with GP/Member Practice events scheduled in addition to attendance at existing CCG fora to discuss the design of the IUC service. Letters for stakeholders have been produced, informing them of the project and how to engage if desired. Fortnightly highlight reports are submitted to the CCG Accountable Officers. 5.3 Finance and Activity

4 Due to changes in project resourcing this workstream has been slower to mobilise. However, finance and Business Intelligence leads are now in place and work is underway to finalise the formal collaborative agreement (for approval alongside full business case), develop the activity and financial model and agree the financial envelope for the procurement. An initial Finance sub-group meeting was held in July 2016, with further meetings planned during September, to include representatives from each CCG. 5.4 Procurement The Procurement workstream is overseeing the development of the Pre Qualification Questionnaire (PQQ) and Invitation to Tender (ITT) documentation and managing all interaction and communication with the Provider market. The formal procurement process is planned to commence in early November. A market engagement event is planned for the end of September. 5.5 Enablers The Enablers workstream is responsible for IM&T, Telephony, Estates and HR. System interoperability requirements are being defined within the service specification in line with local digital roadmaps. The current IM&T and Estates profile is being established to inform the specification and modelling. Requests for TUPE information have been issued to all incumbent affected providers. 6. Timeline The timeline to deliver the Project has been structured into seven phases: Phase 1: Planning and Strategy [Dec 2015 August 2016] Phase 2: Engagement [April 2016 September 2016] Phase 3: Development of Service Specifications [June 2016 Sept 2016] Phase 4: Governing Body approvals to commence procurement and restricted procurement process [October 16 to March 17] Phase 5 Mobilisation [April 2017 October 2017] Phase 6: go live intensive performance and Contract Management with an Evaluation and Review [November 2017 April 2018] Phase 7: Return to Business as usual

5 7. Conflict of Interest Guidance and a process specific to the IUC project have been developed and approved by the Programme Board, following circulation to CCG Accountable Officers. The governance and management of Conflicts of interest (COI) have always formed a part of good procurement practice and recently been enhanced and refocused by the inclusion of COI within the 2015 Procurement Regulations (PCR2015). To support this and reflect the challenges within the NHS as we move closer in the integration of services, NHS England has produced an updated guide to Conflict of Interest and the management of such by the CCGs. Conflicts of interest could arise where individuals who are involved with the IUC project may have links to a commercial organisation that could bid for the tender. These links could be direct or through association (e.g. a family member or a friend). This could give those organisations a competitive advantage if they had access to tender and procurement documentation prior to the release of these documents as part of the procurement timelines. The risk of challenge around conflict of interest is assessed as being high and therefore adherence to the agreed process is paramount to ensure the success of the project. 7.1 COI Process As set out in the COI guidance, the following process is in operation for the IUC project: An individuals working on the IUC Project are asked to complete a Conflict of Interests Declaration Form. Completed COI forms are sent to the central project team and filed centrally, along with any supporting information regarding the details of conflicts and mitigating actions agreed. The Procurement Lead advises the Project Team / Programme Board regarding levels of risk and mitigating actions. The Programme Board maintains overall responsibility for overseeing and managing any potential COI. The central project team (Procurement Lead / Project Manager) maintains a register of all individuals who have completed a COI form, or are required to. The register summarises any conflicts identified and notes mitigating actions. Any restricted project documents are only to be shared with approved individuals. A staged approach has been taken whereby individuals involved in the project are deemed to have differing levels of access, and thus differing risks and mitigations regarding potential conflict of interests. This approach has been taken to enable maximum engagement and involvement during the design phase without exposing the CCGs to challenge during the governance and procurement phases of the project. 7.2 Proposed Process Delegation of Authority for Approval As noted above, the IUC Programme Board and Delivery Group are working to develop a final service specification and associated business case, along with a Collaboration Agreement to underpin joint commissioning and contract management.

6 Under normal circumstances, these documents would go through each CCG s governance routes, requiring final approval from each Governing Body. However, feedback from the provider market has suggested the potential involvement of local GP-led organisations in the bidding process and therefore the focus on identifying and managing potential conflicts of interest has extended to members of those forums that will review and approve the IUC business case. It is anticipated that several Governing Body members from each CCG will be identified as having a conflict of interest, and so therefore cannot take part in the approval process affecting whether the Governing Body has a quorum required for decision-making. As a solution to this, each CCG has been asked to identify an approval process that adheres to COI principles, while still ensuring robust decision-making in line with governance procedures. It is proposed that CCG Governing Bodies delegate decision-making authority to a nominated group, which will receive and be asked to approve the full business case (including Service Specification and Collaboration Agreement) following IUC Programme Board sign-off at the start of October. The nominated groups will include clinicians where possible, following a risk assessment based on COI declarations. The specific process proposed for Castle Point & Rochford CCG is: Governing Body to agree process and delegation of authority to Finance & Performance Committee to approve the business case on behalf of the CCG Assessment of potential COI all Governing Body members and Finance & Performance Committee members Confirm any Governing Body members to join the Finance & Performance Committee meeting (ie if they do not have a conflict) Confirm whether any Finance & Performance Committee members do have a conflict and are therefore excluded from the approval process for this item Business Case and associated papers to be reviewed by Finance & Performance Committee (part 2 expanded/reduced membership based on COI assessments) on 20 October

7 Impact (1-5) Likelihood (1-5) Initial RAG 8. Risks A full risk register is in place for the project, which is reviewed on a fortnightly basis. The summary below highlights the highest areas of risk as identified by the Programme Board. Risk No. Description of Risk Consequences Mitigation 1 Clinical and operational new service creates service duplication Duplicate service delivery within other services (particularly unscheduled and primary care), leading to inefficient use of resources and duplication of patient pathways and payment. Clinical design group to be aware of current and intended service delivery through CCG leads Engagement with local clinicians to ensure visibility over service developments Use of commissioning standards Project Delivery delays to design phase of the project Procurement and mobilisation are delayed (IUC would launch in winter ) Current contracts require further extension which raises risk of challenge Robust project management and planning Commitment from CCGs through PID to identify resource and maintain focus Expert advice taken on extension to current contracts Delays to service improvements to patients 3 Clinical and operational workforce capacity to deliver new IUC service Service cannot be delivered to the specification Service is not resilient Impact on other urgent and emergency care services Specification to enable range of clinical staff to be utilised and model to encourage innovation and collaboration to maximise use of resources Close liaison and working between clinical design and finance group 4 Project Delivery Affordability CCGs are unable afford specified service Business case is not approved CFO lead identified Finance group includes representatives from all six CCGs Consideration of wider system impact of IUC service 9. Recommendations Members of the Governing Body are asked to:

8 1. Note the progress of the Integrated Urgent Care (IUC) project; and 2. Approve the delegation of authority as set out in section 7.2 to approve the full business case and associated documents.